SU1496781A1 - Method of treatment of purulent-necrotic injures of the lower extremities in diabetes mellitus - Google Patents

Abstract

This invention relates to medicine, namely to surgery. The purpose of the invention is to reduce the number of high amputations and intoxication phenomena. The affected limb is affected by a CO ₂ laser with a power of 15–20 W at the output of the fiber, 3-4 mm in diameter for 1.5–2 s repeatedly at the border of necrosis and viable tissue to the depth of the viable layers, and then the necrotic area is treated with a defocused beam with a distance of 8–10 cm, a beam diameter of 10 mm for 2–4 s, which makes it possible to preserve the affected limb, reduce the number of high amputations, and delimit the pathological process.

Description

This invention relates to the field of medicine, namely surgery.

The aim of the invention is to reduce the number of high amputations and intoxication phenomena.

The method is carried out as follows.

The patient is treated with conservative therapy: angeoprotectors, antispasmodics, intravenous antiplatelers, rheological mixtures, antibacterial therapy. Then, a focused laser beam with a power of 15–20 W, a diameter of 3–4 mm for 1.5–2 s affects the necrosis edge at the border with healthy tissue to the depth of the viable layers, and then the necrotic area is treated with a defocused beam from a distance of 8 -10 cm, beam diameter 10 mm for 2-4 s. For a course of 2-6 sessions.

Example 1. Patient G., 59 years old. Was admitted to the hospital in the state of moderate severity. Pale skin, worried weakness, lack of appetite, heart rate 90

per min, BH 26 per min. Human foot sharply swollen, hyperemic. Sh-4 fingers of black color, 5 fingers purple-bluish. Pulsation is determined at the level of the popliteal artery. Diabetes mellitus for 14 years. Diagnosis: wet diabetic gangrene of the right foot.

The patient received an infusion therapy: reopiglyukin, hemodez, antispasmodics, angeoprotectors, cardiotonics. In the dynamics of intoxication increased, swelling and hyperemia spread to the lower third of the leg. Produced laser processing on the proposed method, swelling and hyperemia decreased. Repeated laser processing. Edema no, hyperemia of the foot is negligible. Then HBO therapy was started. 3-4 amputations are performed. Then again affected by the CO2-laser according to the proposed method. The patient was discharged home in a satisfactory condition. The skin on the foot of the usual color, the wound in place of the removed fingers granulates.

four

Q

WITH

Example 2. Ill L. 65 years. She was admitted to the clinic in the state of moderate severity. The severity of the condition is due to intoxication. Complaints of weakness, pain in the right foot. HR 100 per minute, BH 24 per minute. The rights of the foot are swollen, the first finger is sharply swollen, black, the nature of the necrosis is wet. Phenomena of lymphadenitis on the rear foot. The pulsation of the great vessels is determined at the femoral and popliteal level. Diabetes with 22 years. Diagnosis: diabetes mellitus, diabetic gangrene of the right foot. On admission, conservative therapy was carried out: angeoprotectors, antispasmodics, intravenous antiplatelers, rheological mixtures, antibacterial therapy was carried out. Then, a focused laser beam with a power of 20 W, an exposure time of 1.5 s, formed a “demarcation groove at the base of the first toe of the right foot. Edema of the foot is significantly reduced. Repeat necrotomy laser. The edema of the foot disappeared, the effects of lymphadenitis were cropped. Intraarterial injections of Kevzol, 1 g each, No. 4 - into the right femoral artery. Repeated laser necrotomy to the bone focused beam on the proposed method.

Exarticulitis of the first finger in the metatarsophalangeal joint. The patient was discharged home in a satisfactory condition. The skin on the foot of the usual color, no swelling. In the place of the removed finger there is a wound, covered with a coagulation film, without a detachable one.

The proposed method of treatment is applied in 37 patients. This method allows to reduce the number of high limb amputations, to delimit and stabilize the pathological process.

Claims (1)

Invention Formula The method of treatment of purulent-necrotic lesions of the lower extremities in diabetes mellitus, including the introduction of drugs and HBO therapy, characterized in that, in order to reduce the number of high amputations and intoxication, the COG laser output power of the fiber 15-20 W, diameter 3-4 mm for 1.5-2 s repeatedly at the border of necrosis and viable tissue to a depth of viable layers, and then the necrotic area is treated with a defocused beam from a distance of 8-10 cm, beam diameter 10 mm for 2-4 s.